Abortion Care Flashcards
What type of drug is mifepristone?
Competitive progesterone receptor antagonist
What is the mechanism of action of mifepristone?
- Inhibits progestogenic effects on the endometrium and myometrium
- Degeneration of the decidual endometrium (which can cause detachment of the trophoblast and reduced synthesis of bHCG by the syncytiotrophoblast)
- Cervical softening and dilatation
- Increases contractility of myometrium and its sensitivity to prostaglandins
What proportion of women experience vaginal spotting after mifepristone?
50%
What type of drug is misoprostal?
A prostaglandin E2 analogue
What is the mechanism of action of misoprostal?
Uterotonic/cervical ripening:
- Collagenase activation causing collagen breakdown within the cervical stroma
- Myometrial smooth muscle contraction
- Reduction in cervical tone
What is the upper limit for home administration of misoprostal in England?
11+6/40
What proportion of women will have a TOP in the UK within 1 year postnatally?
1 in 13
What plane should be used in taking a HC measurement?
Transthalamic plane
How many unsafe abortions occur each year?
25 million
What proportion of women will get nausea, vomiting,
diarrhoea, chills and fever with miso?
1 in 10
What is the risk of continuing pregnancy with abortion?
Medical abortion - 1 in 200
Surgical abortion - 1 in 1000 (higher in pregnancies <7 weeks)
What is the risk of needing further intervention to complete the abortion procedure?
Medical abortion:
<14 weeks: 70 in 1000
>14 weeks: 13 in 100
Surgical abortion:
<14 weeks: 35 in 1000
>14 weeks: 3 in 100
What is the risk of infection with abortion?
1 in 100
What is the risk of severe bleeding requiring transfusion after an abortion?
1 in 1000
What is the risk of cervical injury with a surgical abortion?
1 in 100
What is the risk of uterine perforation with a surgical abortion?
1-4 in 1000
What is the risk of uterine rupture in 2nd trimester medical abortion?
<1 in 1000
In what conditions is there a theoretical risk associated with mifepristone (consider miso only abortion)?
- Severe uncontrolled asthma
- Chronic adrenal failure
- Inherited porphyria
What is the concern regarding LONG TERM steroid use and medical abortion?
Since mifepristone is a glucocorticoid receptor antagonist, it might inhibit the action of the steroid therapy and exacerbate the
underlying condition
What antibiotic regime can be considered for prophylaxis following STOP?
Oral doxycycline 100mg twice a day for 3 to 7 days, starting within 2 hours of the procedure
(there is evidence that a 3-day course is as effective as a 7-day course)
How can an EMAH be confirmed successful?
With either a low-sensitivity urine pregnancy test (detection limit 1000IU hCG) from 2 weeks after
treatment or with a high-sensitivity test (detection 50IU hCG or less) from 4 weeks after treatment
What are the recommended timescales for treatment (RCOG)?
Abortion services must offer assessment within 5 days
Should offer the procedure within 5 days of the decision to proceed
For NICE it is 7 days for each
When should feticide be performed?
From (and including) 22+0 gestation to prevent live birth
Does paracetamol reduce pain in abortion?
Oral paracetamol has not been shown to reduce pain more than placebo during medical
abortion and is not recommended
How long should a HSA1 (Certificate A in Scotland) be kept for?
3 years
Does a HSA2 require a 2nd signature?
No
Must be completed within 24 hours of an emergency abortion
Must be kept for 3 years
How long before the HSA4 (England) needs to be sent?
Sent to the CMO within 14 days of the abortion taking place
How long before the Notification Form (Scotland) needs to be sent?
Sent to the CMO within 7 days of the abortion taking place
What proportion of abortions are carried out under Ground C?
97%
What is the maternal mortality rate associated with abortion? (UK 2006-08)
0.32/100 000 maternities
What is the maternal mortality rate? (UK 2006-08)
11.39/100 000 maternities
What proportion of women are still bleeding 2 weeks after their medical TOP?
22% (greater chance the greater the gestation)
What proportion of women <24 currently have CT?
5-10%
What is the superior dilator at 14+0 gestation?
Osmotic dilators
Although mife may be used up to 18+0
At what abortion gestation should anti-D be offered (NICE)?
10+0 gestation+
What medication regime should be offered between 25 and 26 weeks?
200 mg oral mifepristone, followed by 400 micrograms misoprostol (vaginal, buccal or sublingual) every 3 hours until delivery
What medication regime should be offered between 25+1 and 28 weeks?
200 mg oral mifepristone, followed by 200 micrograms misoprostol (vaginal, buccal or sublingual) every 4 hours until delivery
What medication regime should be offered after 28 weeks?
200 mg oral mifepristone, followed by 100 micrograms misoprostol (vaginal, buccal or sublingual) every 6 hours until delivery
What proportion of pregnancies end in abortion in the UK?
25%
Which part of The Abortion Act cover conscientious objection?
Section 4
Which act covers selective reduction of multiple pregnancy?
Human Fertilisation and Embryology Act 1990
